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Friday, September 27, 2013

Ivy has been (figuratively) running from one milestone to another. She started commando-style crawling right after she turned 5 months old. Just this week she crawled for real. She has started to twist from a crawl into a sideways supported sit. She has otherwise skipped the sitting phrase altogether. Because sitting is for babies.

And this morning, Eric found her standing up, cruising along the open dishwasher. He turned away for a moment, and she pulled the dishrack off and on top of herself. Slow down little Ivy! You have plenty of time to learn how to walk and run. Just be a baby for a little longer.

She's all over the house, getting into the houseplants, stuffing every scrap of paper she can find into her mouth. She LOVES paper. I'm always fishing out wads of shewed-up paper from the top of her mouth.

She pees really well whenever I cue her, and we occasionally get some poops too. It's a bit tricky because she only poops once every several days. And talk about stinky poop! I thought breastmilk poop wasn't smelly until I had a baby who poops infrequently.

Sleep: not great. She loved the baby hammock I made last month for about a day. Grrrrr. I finally changed a few things that seem to have helped. I stopped swaddling her arms, and I took away the rolled-up towels that kept her from rolling over in her crib. And I stopped co-sleeping at night (sniff). She's still next to me in her crib, but she was rolling and wiggling so much at night that no one was sleeping well. Now, she can be a ping-pong ball all she wants in her crib. And she can sleep on her stomach--definitely her preferred position. Some nights are okay, but more typically she still wakes up 3-4 times in a 12-hour stretch.

She's so interested in what her siblings are doing. She's started making little growling/roaring noises (we call them dinosaur noises), which makes us bust out laughing.

Getting her to nurse is next to impossible unless I'm in a dark, quiet room. She likes to fiddle with her ear when she nurses. She definitely knows what "nurse" means. Now if she'd only do it! She's still plenty chubby, weighing in at 16 pounds a few weeks ago.

Monday, September 23, 2013

A blog reader, Michelle, sent me her breastfeeding stories. She has four children and was never able to nurse exclusively, despite trying everything. I'm so glad she was willing to share her experiences. Some women cannot produce enough milk for their babies. For those who want to nurse but cannot, the regret and frustration can be overwhelming.

Michelle commented to me: "I am very grateful that I was able to nurse my girls for however long I could. I wish I were still nursing my fourth! I am glad to that I finally decided to pursue all solutions because I needed to realize that nothing I did would help. That knowledge helped alleviate a lot of guilt. If I ever have another child, I won't beat myself up so much and just enjoy what I can give them!"

I want to encourage anyone who can to donate breastmilk to mothers in need. You can go through a milk bank, or you can donate directly. I chose the latter option because milk banks charge upwards of $4/ounce and they pasteurize the milk. I was screened for any common infectious diseases (the same ones that milk banks screen for) and shared the results with the donor family. You can visit Human Milk 4 Human Babies to connect with families in need.

My first pregnancy was very easy. The only unusual thing about it was that my breasts didn't grow, but since it was my first, I didn't notice. After a traumatic delivery with 4th degree tearing, I struggled getting my baby to latch but she eventually did. 72 hours postpartum, my milk came in and we started our nursing relationship.

At five weeks postpartum, my milk supply suddenly dropped. I thought it was because of two reasons-- the first being that at two weeks postpartum, I had gone back to school to finish my last year of college and, since I didn't have a breast pump, instructed the babysitter to feed my daughter formula when she was hungry. The other reason, I thought, may have been because my daughter was going through a growth spurt.

After two weeks of near-constant nursing and lots of crying, I realized I needed to supplement. I had been co-sleeping, drinking a lot and taking brewer's yeast (the solutions suggested to me by my lactation consultant) but I simply wasn't producing enough. I started supplementing a lot but continued nursing a little until we weaned at eleven months.

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My second pregnancy was also easy and this time my breasts did grow a little. I had a much easier labor with very little tearing and nursed almost immediately after. My milk came in at 48 hours and all seemed to be going well until I got mastitis twice the second week postpartum. After that my milk never recovered and I started supplementing at three weeks postpartum. I also experienced postpartum depression, which negatively impacted my milk supply and my daughter weaned herself at 7 months. I was very sad, but my daughter was finished.

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My third pregnancy was a joyful one and healing in many ways. My breasts grew a lot and I had an easy, natural delivery. My third daughter latched easily and nursed well. My milk came in well at 48 hours. I was determined to do everything right and nurse full time, so I obtained a hand pump and for the first six weeks, I would pump one side while nursing on the other--even in the middle of the night. I got mastitis but caught it early enough that it didn't affect my supply.

At six weeks I figured that I had established a good supply and stopped pumping. At around four weeks my daughter had started crying every night for hours and was growing slowly, but I felt like I had enough. When I stopped pumping, however, I saw a very fast decrease in my supply. At seven weeks, I began taking fenugreek daily to help my supply, which I did until she was about four months old. At that point I had to start supplementing, in spite of the fenugreek. Once I started supplementing, my daughter stopped crying at night and started growing faster. We supplemented and nursed until she was 14 months old. Supplementing brought about a huge personality change in her and she turned into a happy, easy baby.

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My fourth pregnancy was harder. There was a lot of stress, some antenatal depression, and I had incredible hip/sciatic pain. I would crawl to the bathroom in the middle of the night because it was too painful to walk. I was determined to breastfeed, but I started getting concerned when I couldn't express any colostrum one month before her birth. My breasts grew, but not nearly as much as my third pregnancy.

Her birth was an amazing, unassisted home birth. She started screaming as soon as she was born and didn't stop for 30 minutes. I tried to get her to latch and finally she latched at 30 minutes postpartum, but didn't nurse well or frequently the first 24 hours. I kept her at the breast for nearly 36 hours, but she struggled with her latch and bobbed on and off. She figured out her latch around 72 hours. My milk also came in about then, but I wasn't engorged. I never suffered any engorgement at all.

At 6 days postpartum, we received a call from her pediatrician stating that her newborn screening results had come back abnormal. We spent the next 3 days meeting with doctors and specialists, with a huge amount of stress and very little sleep. She was diagnosed with MCADD, a rare but fairly easy to manage metabolic disorder. One of the management techniques was frequent feeding, every three to four hours. She was a good sleeper, so I had to set alarms throughout the night to wake up to feed her.

By the time she was 10 days old, I was on Reglan to increase my supply. We were in the middle of selling our house and the stress of that, combined with the stress of her diagnosis and lack of sleep, impacted my already tenuous supply. My supply had dropped the few days we were learning about her diagnosis and I simply couldn't keep up.

In order to build my supply back up after taking Reglan, I started sleeping nine to ten hours a day, consuming about 100 ounces of fluid and about 3000 calories. I put on weight. I obtained a double electric breast pump and pumped in between nursing sessions. I co-slept, took my Reglan prescription (even convinced my doctor to give me a refill) and began taking the MoreMilk Plus tincture. I nursed her as frequently as she wanted, often sitting for three to four hours in the evening just to get her to sleep. I continued this regimen of milk-increasing tactics until she was 9 weeks old. By this point, we were getting ready to move and she was so hungry she screamed all day in my arms. I would nurse her every 45 minutes for 20 minutes, pump during or in between and do all the other things I had been doing. She would bob on and off, cry the whole time we were nursing and was not satisfied after. She would scream most of the day and nursed constantly at night. I was completely exhausted, mentally and emotionally.

In order to make our move easier, I began to pump instead of nursing so people could feed her while I was packing. I have an overactive letdown reflex and can easily pump. It was then I realized that I was only producing seven to ten ounces a day in spite of everything. I had only been supplementing with four to six ounces of formula a day up to this point. I realized her crying wasn't because of colic, but because of hunger. I was basically keeping her fed just enough to avoid a metabolic crisis.

So at eleven weeks old, six days before our move, I stopped nursing. The first day on the bottle, she ate five ounces every two hours. I wasn't even engorged. We realized that she was starving. We also realized that as part of her metabolic disorder, she was only able to use a certain amount of her food as calories and needed to eat twice as much as my other children in order to get enough calories. Even now, at four months, she is very petite but eats voraciously. I wasn't producing enough to feed a regular baby, much less one who needed extra calories.

That decision proved to be the right one. We were able to move much more easily. She started putting on weight. She hadn't smiled much but she began smiling more. I could finally take a short shower without her screaming. I could even put her down to do the dishes!

The biggest difference was her personality change. When we bottle fed her, she stopped screaming. She was still a needy baby, but she was actually content in my arms or a carrier. She slept peacefully. She cooed at me. She was a different baby.

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In the midst of the challenge with my fourth daughter, I came across some articles that talked about lactation failure and insufficient glandular tissue. I don't have all the physical characteristics, but I do have very wide set and small breasts. I found that there were almost some genetic markers in my family that could have clued me in too. In talking with my father's mother after the birth of my fourth daughter, I learned that her breasts never changed during pregnancy and her milk never came in with any of her three children. My grandmother has three sisters, and none of them had their milk come in. My great-grandmother and great-great-grandmother were also unable to nurse and relied on other things to feed their babies. My great-great had 13 children and gave them all meat broth!

It has been two and a half months since we weaned. I so desperately wanted to nurse all of my children, and, despite exploring every option, I simply can't nurse. The realization that I will never be able to nurse a baby successfully has been excruciating. I truly love nursing. I treasure the moments of closeness. Cuddling skin to skin in the middle of the night. I miss the peace that comes from nursing.

I also feel guilty. Looking back on my third daughter, I realize that I wasn't producing enough for her. I feel a lot of guilt over my selfishness in wanting to nurse her and being unwilling to see she wasn't thriving. I feel guilty knowing that I'm not providing antibodies for my fourth daughter. I feel guilt that I'm using formula.

I pleaded with God to change my body, to help me nurse my babies. I pleaded that He would give me a miracle. But it seems that this experience has been one to humble me.

Breast is best and I love to breastfeed. I am grateful for the times I was able to breastfeed my daughters. I will always cherish those moments.

Thursday, September 12, 2013

If you're at all part of the birth world, you've probably heard of one or more of these terms. I've had four pregnancies, four labors, and four babies all using some kind of hypnosis.

Basic idea of hypnosis for childbirth (in my words): the mind is extremely powerful and malleable. Through deep relaxation, conscious breathing, and visualization, you can reprogram yourself to respond positively to the sensations of labor.

How and when I listened to the hypnosis recordings:

For my first baby, I listened to the two hypnosis tracks provided with Marie Mongan's Hypnobirthing book. I listened to one track every day for the last two months of pregnancy. I didn't have an mp3 player at the time, so I listened on my stereo system. I turned the track on early in my labor when I started having contractions. Once I was up and moving around the house, I turned it off.

For babies #2 and #3, I used the Hypnobabies Self-Study Program. You're supposed to listen to one of the hypnosis tracks, along with the birth affirmations track, daily starting at around 30 weeks. I ended up skipping the affirmations most days. I was busy enough with little children that I didn't have time for two sessions. I put the tracks on my mp3 player when I lay down in bed at night and usually "slept" through most of them, waking up at the end of the track. I listened for a few hours early on in both labors. But once things really started cooking, I was no longer interested. Well, more like I was too occupied with labor to focus on anything else!

For baby #4, I used the Birth Relaxation Kit, a complete birth hypnosis program. Like with my last two babies, I listened at night when going to bed. I listened a bit during early labor, but not once the work started in earnest.

I'd consider using hypnosis in labor a small added bonus. For me, the real value of hypnosis came during pregnancy. The daily deep relaxation was priceless, especially when I was dealing with severe sleep issues and the typical worries of pregnancy (will the baby be okay? what if _____ happens?).

Does birth hypnosis work?

I'd answer with a qualified yes. Some hypnosis programs emphasize having a comfortable, pain-free birth. I was always a bit hesitant with those promises. I totally believe that some women do have pain-free, comfortable births through hypnosis. But I was also wary of trying to force my experience into a box (and then being disappointed when it didn't fit).

Rather than aiming for being pain-free or even comfortable, I wanted to embrace all the sensations of labor without judgement, to work through the process without fear, to feel everything and to fight nothing.

I don't know why some poeple can do hypnosis programs and feel no pain ("I only felt pressure," they often say, "really intense pressure but no pain"). Or why others like me feel all the sensations--good and bad, pain and pleasure, pressure and power. I theorize that it depends on where the hypnosis affects the nervous system.

Some women truly can "anesthetize" themselves and eliminate feelings
of pain entirely. (I still wonder how they can do it, honestly, since
there is no way I can imagine feeling the sensations of labor without
pain being one of them.) But for them, hypnosis works here to filter, or
perhaps the better word is "alter," the sensations of labor so that
they are not experienced as pain or discomfort once they reach the
brain. Like this:

For me, hypnosis doesn't control the sensations going into the brain. I feel and experience everything. The hypnosis kicks in at the other end, where the brain reacts and sends out signals. The hypnosis helps me experience labor without fighting or struggling against it. So instead of controlling what I feel, hypnosis helps me control how I react and interpret what I'm feeling. Like this:

Mothers using birth hypnosis
are often, but not always, outwardly calm. I tend to remain quiet and focused during active labor,
although I'm more vocal when I'm pushing. I don't think you need to act calm or quiet to be effectively hypnotized. Remember that hypnosis is really just very deep relaxation and meditation.You can be up, moving, and talking and still be in a hypnotic state.

Saturday, September 07, 2013

I recently tested and reviewed the Breastflow Memory Pump by The First Years. The company has generously offered to give away a pump to a Stand and Deliver reader!

The fine print:

Open to U.S. residents

Each household is only eligible to win 3 TOMY products, via blog reviews and giveaways, each calendar year. Only one entrant per household per giveaway. If you have won the same prize on another blog, you will not be eligible to win it again. Winner is subject to eligibility verification.

Monday, September 02, 2013

I've been pumping and donating since Ivy was 2 weeks old. I've used two pumps, the Ameda Purely Yours and the Medela Personal Double Pump (see my review here). Breast pumps are a big investment and are usually non-returnable. You can't test them out in the store, so you have to go by reputation, cost, or word-of-mouth.

The First Years company just came out with a new double electric breast pump, the Breastflow Memory Pump (approx $179), and offered to send me one to test out. It's an upgrade of their earlier model, the miPump Double Electric Pump (approx $79). The big change from the old model to the new? An electronically controlled pump that can store data (time, duration, suction & speed settings, and volume on each breast) on the last 10 pumping sessions.

The Breastflow Memory Pump comes with a lot of stuff:

zippered cloth bag

insulated cooler bag that holds 4 bottles

reusable icepack

two Breastflow bottles, nipples, and covers

rechargeable pump with AC adaptor

tubing

two sets of flexible silicone shields (M and L)

a handle that allows you to double pump with just one hand

and, of course, two pumping kits

Okay, let's get down to how this pump performs.

It is slow. Agonizingly slow. It sounds like a dying cow. It has 10 suction settings, but only 3 cycle speeds, the fastest of which is just 36 cycles per minute.

I need a much faster cycle frequency to get a good letdown response. I prefer Medela's 75 cycles/minute over Ameda's 30-60 cycles/minute. And I would probably use a faster cycle frequency at first if that were an option (as it is with the Medela Pump-In-Style). For more on cycle speeds, read my Ameda & Medela review.

I don't know if all women respond similarly, but it takes me much longer to pump a similar volume with the Breastflow Memory Pump than with the Ameda or Medela models. I imagine it would be relatively easy for the company to program faster cycle frequencies, since they are controlled electronically rather than mechanically.

I did a little experiment when I was testing this pump and timed how Ivy's suck patterns. When she first latches on, she nurses really fast, around 150 sucks/minute. Once my milk lets down, she slows down to about 80-100 sucks/minute. A good breast pump should come close to these patterns.

Pros of the Breastflow Memory Pump

It was fun to program in data from each pumping session, although I don't need to keep track for any particular reason. I wonder why the memory only extends to 10 previous sessions--why not 100? 200? If, as they advertise, the memory feature will help determine what settings get the best response, you'll need a lot more than a sample size of 10 to come to an accurate conclusion.

I like that the pump is small, rechargeable, and portable. The Ameda and Medela models both require a power outlet.

The optional handle lets you pump with just one hand. It's big and a bit awkward to hold, but it also frees up one hand. I used it about half the time. The other half, I just leaned over and balanced the bottles on my thighs. I you really need your hands free--say you're pumping for all your baby's feeds or are at work--then I'd advise getting a hands-free pumping bra.

This pump comes with two sizes of flexible silicone shields. (They're labeled 1 and 2, but honestly I couldn't tell the difference between the two!)

Includes an insulated cooler with a reusable ice pack.

Cons

Hands down, the biggest drawback is the slow pump cycles.

The Breastflow Memory Pump is an open-system pump. Like the Medela pump, contaminants can enter the tubing, work their way into the motor, and come back into your pumped milk. If you want a pump that won't contaminate your milk, or one you can share between users, go with an Ameda Purely Yours or Hygieia Enjoye. Both are closed-system pumps.

The First Years is not a WHO Code compliant company because of how it markets its infant feeding bottles. The only breast pump manufacturer that is consistently compliant is Hygeia. (Ameda sometimes makes the list, sometimes not.)

The pump kits have more parts than the Ameda or Medela. Not a huge difference for cleaning, but worth noting. On the upside, you can put all the parts--valves included--into the the top rack of a dishwasher.